Sluggish Cognitive Tempo?

I have been lurking here for a while. My husband of 20 years was recently diagnosed with ADHD-Inattentive type. It took my leaving to get him into diagnosis and treatment. I have experienced many of the problems discussed here: his chronic unemployment and related financial problems, mental exhaustion and feeling like the only responsible adult in the house because he cannot seem to make or keep a to-do list, frustration and hopelessness, etc.

We are actually back together and optimistic now. I am working on limiting my attempts at control to my own behavior, and trying to understand more about his condition so I can see it as a disease and not a moral failing. He is really trying to remember things, back in school, etc. Unfortunately, he lives in a very rural area, where there is no one who can coach him, and the only psychiatrist within 100 miles who takes our insurance is...long story short...unhelpful. He tried Ritalin, which gave him more energy and helped him process his feelings, but was not really helpful with his ability to focus. I have been fortunate that he has rarely performed any of the externalizing behavior I've also seen on this forum; no affairs, no addictions, no abusive behavior, etc. (Some deflection/denial and emotional outbursts, but never nasty towards me). He always has treated me like a queen, which is the only reason I stayed for so long. Instead, he is socially withdrawn and full of self-loathing for having been a "failure" all his life. (He is on Wellbutrin for depression as well).

In the course of my research on his condition, I have run across something called SCT (Sluggish Cognitive Tempo), which may be a type of ADHD or possibly a different type of attention disorder. (If they are different, I think my poor husband has both). Symptoms include feeling sluggish and slow, both physically and mentally (not IQ, just processing speed), being prone to errors, being in a mental fog, and being shy/socially withdrawn. This describes my husband to a "T", along with the working memory and time orientation problems of ADHD. These characteristics have led my husband to feel that he has been a shy, lazy, clumsy failure his whole life, despite having an above-average IQ. (Being called those names by his sonofabitch stepfather as a child merely adds to the issues that he'll be working on in therapy. Sigh.)

Anyway, I was wondering if anyone on here has experienced the same issues and can offer help. He will be moving in a couple of months to be with me physically and geographically again, but in the mean time, working with any kind of expert is unrealistic. Any self-help strategies for coping would be helpful, or even anything to boost his self-confidence. My greatest fear is that he is so invested in seeing himself as a failure (and has no realistic experience with success), that he feels doomed to fail at his efforts to change and save our marriage, and it will become a self-fulfilling prophecy. Thank you!

I have SCT and ADHD PI. I have to be on a stimulant to be 'motivated' and I notice I'm a little less irritable when I'm on one because I'm not so frustrated. Vyvance seems to work the best for me with Adderall coming in second. I feel a LOT better on a stimulant, I feel like I am 'normal' because it brings me up to normal speed. Everyone tells me that I am slow but when it comes to trying to get around a store other people frustrate me because they are moving slower than me. The people around me get frustrated because x task should only take x time, I was lucky to keep my seamstress job because I was 'slow'. I've learned that contract jobs do NOT work for me because I feel comfortable with a lighter load of work which means less $$ and that will increase my anxiety because bills become an issue. One thing my mom has mentioned shes noticed is that if I get too overwhelmed I will break down and give up completely so I am working on keeping my tasks and responsibilities small so I don't create a break down.

Sorry if this is a little scattered, even though I feel normal I'm still uneasy about what I say and type because I realize it doesn't always 'flow' but if you live with someone like me it might feel familiar LOL!!

Some people think its a food allergy, eliminating gluten and refined sugar seem to help... I need to work on that myself. Oh and I have also been looking for a essential oil blend that works.

SCT describes my symptoms as well (though my medical records use the more commonly recognized designation of ADHD Primarily Inattentive). I'm also being treated for depression and have been dysthymic most of my adult life. Your situation with your husband seems to mirror mine with my spouse, though in our case our future is much less optimistic.

I've been on most antidepressants at various times and have seen many different therapists for depression. The antidepressants generally help me initially, but not enough and not long term. Eventually the positive effects seem to wear off, possibly because the ADHD/SCT is not being addressed.

More recently (last year and a half) I started receiving treatment for ADHD and depression simultaneously. I know this won't help in your case but I also see I psychiatrist, a psychotherapist, and a marriage counselor on a regular basis. I was put on Vyvanse and Lexipro (my psychiatrist would not prescribe Vyvanse with Wellbutrin) and I got very good results. I felt as if I'd woken from a coma. However, I'd also had a major trauma before the treatment began (discovering my husband's 2-year affair) so there was a lot of shock and anxiety that woke me up as well. Perhaps that might correlate somewhat to the shock that compelled your husband to action when you left him.

I've been on this particular cocktail of medicine and have been seeing all the therapists for over a year now. During that time I've discovered further betrayals from my husband, discovered he was still in secret contact with his lover and was told that he didn't love me any more, he moved out (although he continues to participate in marriage therapy), and only recently he has begun to get past his own shame and self-loathing enough to admit to me how much he feels that I betrayed and rejected him during our 27 year marriage by being depressed, inactive, inattentive, chronically underemployed etc. Apparently even though he started out with the typical post affair apologies and attempts to win me back and save our marriage, he wasn't really committed because he secretly felt such strong unacknowledged resentment towards me. It would have been great if he had educated himself before on depression or ADHD, rather than getting angry at me for being sick. I would have even preferred that he did get angry and pissed to my face and confronted me with my failings so that I might have understood how my desperate unhappiness wasn't just my problem alone and was affecting the people I loved. I would have preferred some unhappy honesty and marriage counseling or even the demand that I pursue more treatment options or else, instead of being enabled and lied to about how loved I was, feeling paranoid and ungrateful for suspecting her didn't care about me and my unhappiness, while secretly he loathed me and was carrying on an affair. But yeah, all that is a side note, to your problem.

I mention it as a way of saying that I continue to have a lot of troubling symptoms but it's difficult to say whether it's the depression or the SCT/ADHD and how much of it is related to the sucky personal situation I find myself in. Recently however my psychiatrist recommended that I try Concerta and Lexipro to see if that combination will be any more effective on helping me to focus my thoughts and stay on task so that I can get more done and not get so distracted that I end up running late constantly. It's too early to say whether Concerta and Lexipro will be any more effective than Vyvanse and Lexipro.

As for other advice, even with medication he's going to have to retrain his mind to recognize his strengths and to not constantly give in to his internal critical voices. I'm not sure how to do that without a therapist. It's pretty difficult even with a therapist. He's going to need to build positive habits. It's going to be extremely slow work. I'd recommend the Power of Habit but also some ADHD specific management books like Succeeding with ADHD. Once again, it's going to be slow. If he's anything like me, he probably has a great deal of difficulty forcing himself to create new habits. People with our disorder are said to have less positive anticipation and to receive less of a reward from the area of the brain that reinforces a job completed. In other words, our brains don't give us as much of the positive feelings people normally get when they complete a task, so consequently we have less incentive to repeat the action. Other books that my psychiatrist just recommended to me are Julie Morgenstern's Time Management From the Inside Out and Organizing From the Inside Out. I haven't read enough to really recommend these myself yet, but my psychiatrist thought they'd help. They have the usual time management stuff, but there seems to be an emphasis on figuring out what stops a person from following through with the things that they know they ought to do.

For the two of you I'd recommend doing the exercises in the book Couple Skills by McKay. This has actually helped me and my husband more in the last 2 months than our marriage counselor has helped us in a year and a half (and it's a hell of a lot cheaper). It starts with basic issues like how to listen to each other, how to express your needs and ask for changes without turning everything into a blame-fest. After the 1st 3 basic chapters it allows you to target specific issues like negotiating or anger, etc.

Another resource you might try is a web site from a psychologist named Michelle Skeen. (Google michelle skeen create journal.) This site has nothing to do with our specific disorder, but Dr. Skeen does a podcast on relationships and she has this function on her site that allows you to keep a journal. She gives you the option of keeping it totally password protected or sharing it with her. If you share it with her she offers support and advice. No charge. So it might be a way of getting some psychological or relationship help without having a psychiatrist available in your area. It obviously isn't going to replace a good therapist because I'm sure Dr. Skeen doesn't have the time to give extensive feedback to everyone, but she's written me several times and I've found her advice helpful. I think she would be especially helpful with the self-esteem issues and discussing the negative messages that your husband has internalized. You might discover that you also have some of the same negative messages and might want to keep a journal on her site as well. She has some good online diagnostics.

I know I've already written a book with this post and recommended a library's worth of reading, but I'll mention one other thing that has been a good tool for me and might help your husband. I respond well to someone sitting down with me and helping me to brainstorm and develop a plan. I'm not stupid obviously, but I have difficulty with organization, motivation, and just using my executive functions to get from the problem to the solution. Having a discussion about a problem as a couple and then being allowed to give input into how to tackle that problem works a lot better than being told "you need to do X and this is the correct way to do it", etc. As someone who doesn't have your husband's issues you may automatically jump from seeing a problem, to having a fix for the problem, to then assuming that everyone sees the problem as you do, so that if they aren't fixing it it's because they are lazy or willfully leaving the work for you to do. But remember your husband may not have even noticed the problem, or he noticed but it's now become background in a huge unwritten unorganized list of things he intends to do someday when he finds himself motivated, etc. Telling him to do something he's neglected to do is going to have one of two results: either he's going to feel bad because he feels criticized by you, or he's going to feel bad because he already criticizes himself for being such a screw up. (Or possibly: "What?") Remember he's felt incompetent most of his life. He knows he's performing sub par. You telling him what he isn't doing right and then nicely telling him how to do it, may seem like the fastest, most efficient way to take care of the problem. But it's not likely to get the results you want. Taking the time to sit down together and develop a process may seem unnecessary and even a little asinine, however, you might find that just taking that time to invite him into the solution might be more effective and save time in the long run.

Recently my teenage daughter (same symptoms I have) sat down with me and we brainstormed a list of all the boring little jobs that need to be done every day. I guess most people do these without thinking out of habit, but these are the things we don't notice or put off or do once they've reached crisis proportions. Once we figured out what needed to be done everyday just to stay current with the housework, we put up a chart in the rooms where the activity takes place with days of the week across the top and the list of chores down the side. For instance the one in the kitchen has things like: take your morning pills, start the dishwasher, fill the cat's water, put away clean dishes, wipe the counters, sweep the floor, etc. Since posting the chart I no longer have to prompt her, or be prompted myself. You may find if you do this with his participation and cooperation that he'll start to do many of the daily things that otherwise you'd have to nag him or remind him to do. My daughter and I initial the tasks we've done as we do them and I noticed an unexpected benefit was that she started paying attention to whether she was initialing as many items each day as I was. In other words, she not only started doing more without my asking her to, she noticed if the work was being distributed more or less evenly between us.

This may seem like a lot of trouble for something simple. My husband would never have considered something like this necessary. He is not only organized he is on the anal retentive end of keeping track of all his habits and forcing himself to do the same chores in the same order every day and timing and criticizing himself until he does them with greater and greater efficiency. Probably that habit started as a child trying to get his parent's approval by being good/perfect and it became internalized. He wouldn't have thought to take the time for my silly little chart, because he would never have seen the need, and he wouldn't have been able understand why my daughter or I couldn't just be more like him out of orce of will. You might not have such extreme perfectionist habits, but no doubt certain habits and organizational skills come like second nature to you that would baffle your husband. My daughter and I like our daily task chart thing and the fact that we both participated in putting it together helped to make us both invested in it. I think you might have luck with those kinds of ideas, but mainly I just think it's important to approach an issue with a statement like "Well, we've gone another week and I notice we still aren't keeping up with the laundry." (or "...I feel like I'm still doing more than my share of the laundry") "Will you help me figure out a system so that we can get the necessary things done on time without one of us feeling overworked or guilty at the end of the week?"

That's the kind of cognitive way of going about it that works for me. Hopefully it will work for your husband.

Another important thing you can do to help your husband is to make sure you spend more time praising the things he does well and that you want him to repeat, than you do criticizing the things that you don't want him to do. This may not come naturally because he might not be doing a lot of good things and he may be wasting a lot of time on things you wish he wouldn't do when there are so many other things he really ought to be doing. However, chances are he already knows what you don't like him doing, but those things have either become rewarding for him in some way or they are just such entrenched habits that he has a hard time stopping himself even though he knows he should. Reinforcing the few things you want him to repeat will actually go a lot farther toward turning those into habits while raising his self-esteem enough to give him the power to resist the things he already knows you don't like or aren't good for him.

Sorry this post was so long and that I unloaded so much extra baggage with it. I wish you both good luck.